Thromboangitis obliterans (Buerger’s disease) is the most common peripheral vascular disease in Korea, whereas arteriosclerosis is in the western countries.
It is an obstructive vascular disease caused by segmental inflammatory and proliferative lesions of the medium and small arteries and veins of the limbs. Arteriography is essential in diagnosis, which disclosing segmental multiple occlusions of the medium size and small arteries, associated with collateral and distal run-off vessels visualization. With recent development of arteriography, more segmental Buerger’s disease with distal run-off vessels are found.
Treatment of Buerger’s disease consists of conservative measures, sympathectomy, various vascular surgery such as endarterectomy, patch graft and bypass vein graft, and eventually amputation. Bypass vein graft is most effective, but technically difficult, treatment modality among them.
We developed new technique of microvascular surgery which enabled us to revascularize those small arteries such as ant. & post. tibial or peroneal arteries.
Now it is our recent policy to explore all the distal legs whenever we confirm visualization of distal run-off vessels of tibial trification and/or arterial pulse waves around the ankle joint with Doppler ultrasonography, no matter how diseased those appears.
A long length of autogenous saphenous vein was harvested from the ipsilateral leg or from the contralateral leg when the iplilateral vein is deseased and hence unsuitable for grafting.
Breakdown of 11 cases is as follows:
1. Most prevalent incidence is at age group of 31-40, and all patients were male.
2. 9 of 11 patients were smokers.
3. Arteriographies revealed occlusion of lumens, most commonly in superficial femoral arteries, followed by popliteal arteries and ant.tibial arteries.
4. The main type of surgery in all cases was autogenous bypass graft; bypass grafts only in 6 cases (1 case was in-situ bypass), bypass with microendarterectomies in 4, and bypass with subsequent B-K amputation in 1 case.
5. Most common bypass graft was superficial femoral to P.T.A.(6 cases), followed by common femoral to P.T.A.(2 cases), common femoral to bifurcation of P.T.A. & peroneal artery (1 case), common femoral to A.T.A.(1 case; in-situ bypass), superficial femoral to A.T.A.(1 case).
6. Rate of graft failure within 6 months was 30%.
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